Decision-Making Support

Choosing the right type of breast reconstruction is a very personal decision. Each option comes with its own benefits, risks, and considerations. Factors such as the size and shape of your breast, your age and overall health, past surgeries, risk factors like smoking or obesity, the availability of tissue from your body, and the location of your tumor can all play a role.

For example, women who have had prior abdominal surgeries may not be candidates for abdominal-based flap procedures. Talking through these details with your surgical team will help ensure the safest and most effective plan for your unique situation.

Below, we’ve outlined the most common considerations for both implant-based and autologous (your own tissue) reconstruction.

Reconstruction With Implants

Surgery and Recovery

• Requires enough remaining skin and muscle after mastectomy to cover the implant.

• Generally a shorter surgery than tissue reconstruction with less blood loss.

• Initial recovery may be shorter than with tissue reconstruction.

• Often involves several follow-up visits to gradually inflate a tissue expander before the final implant is placed.

Possible Complications

• Infection, fluid build-up (seroma), or pooling of blood (hematoma).

• Blood clots.

• Implant extrusion (implant breaking through the skin) or rupture.

• Formation of hard scar tissue around the implant (capsular contracture).

• Higher complication rates in women with obesity, diabetes, or a smoking history.

• Very small risk of a rare cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), especially with textured implants.

• Rare reports of squamous cell carcinoma and other lymphomas in scar tissue around implants.

Other Considerations

• May not be suitable for women who’ve had chest radiation.

• Often not adequate for women with very large breasts.

• Implants do not last a lifetime—replacement or removal may eventually be needed.

• Silicone implants generally feel more natural than saline.

• FDA recommends periodic MRI scans for women with silicone implants to check for “silent” ruptures.

Reconstruction With Autologous Tissue

Surgery and Recovery

• Typically a longer and more complex surgery than implant reconstruction.

• Recovery period is usually longer.

• Pedicled flap procedures are shorter with a shorter hospital stay.

• Free flap procedures require a microsurgeon to reconnect blood vessels, which is highly technical and requires special expertise.

Possible Complications

• Necrosis (death) of transferred tissue.

• Higher risk of bleeding and blood clots compared to implants.

• Pain or weakness at the donor site (abdomen, back, thigh, or buttocks).

• Higher complication rates for women with obesity, diabetes, or a smoking history.

Other Considerations

• Often creates a breast that looks and feels more natural than an implant.

• Leaves a scar at the donor site.

• Can be a good option if radiation has damaged chest tissue.

Sensation and Nerve Recovery

Regardless of the method, mastectomy usually results in numbness or loss of sensation in the breast. This happens because the nerves that supply feeling are cut during surgery. Some sensation may return over time as nerves regenerate, and surgeons are developing new techniques to help preserve or restore nerve function.

If Reconstruction Fails

Any reconstruction—implant or tissue—can fail if healing doesn’t go as planned. In those cases, the implant or flap may need to be removed. If implant reconstruction fails, a second reconstruction using another approach (such as autologous tissue) is often still possible.